Provider Demographics
NPI:1073975405
Name:DIAZ, CARLOS RICARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:RICARDO
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 N AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-8658
Mailing Address - Country:US
Mailing Address - Phone:850-623-4151
Mailing Address - Fax:850-623-5154
Practice Address - Street 1:5600 N AIRPORT RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32583-8658
Practice Address - Country:US
Practice Address - Phone:850-623-4151
Practice Address - Fax:850-623-5154
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 41831207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine